Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES OPPOSITIONAL DEFIANT DISORDER: ISSUES AND INTERVENTIONS FOR POSITIVE BEHAVIOR MANAGEMENT

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1 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES i OPPOSITIONAL DEFIANT DISORDER: ISSUES AND INTERVENTIONS FOR POSITIVE BEHAVIOR MANAGEMENT Derek Cornett A Capstone Project submitted in partial fulfillment of the requirements for the Master of Science Degree in Counselor Education at Winona State University Academic Semester, Fall 2012

2 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES ii Winona State University College of Education Counselor Education Department CERTIFICATE OF APPROVAL CAPSTONE PROJECT Oppositional Defiant Disorder: The issues and interventions for positive behavior management This is to certify that the Capstone Project of Derek Cornett Has been approved by the faculty advisor and the CE 695 Capstone Project Course Instructor in partial fulfillment of the requirements for the Master of Science Degree in Counselor Education Capstone Project Supervisor Name: Approval Date:

3 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES iii Abstract Children who are diagnosed with oppositional defiant disorder continue to be a struggling population in schools for educators. The purpose of this paper is to propose an integration of Choice Theory and operant conditioning to work with students identified as ODD, and to discuss how utilizing them together in the classroom may be a positive and effective approach to modify student s problem behaviors associated with ODD. Evidence has show brain functioning deficits in children who are diagnosed with ODD in relation to executive functioning and making positive behavioral choices. Choice Theory and operant conditioning have the potential to work together and modify behavior positively in the classroom to create a better learning environment.

4 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES iv Table of Contents Introduction.1 Review of Literature...3 Oppositional Defiant Disorder 3 Characteristics of ODD 3 Neuropsychology & ODD...5 Current Treatment Methods. 9 Treatment in Schools Choice Theory...11 The basic needs Relationships Quality World Treatment with Choice Theory and Reality Therapy Operant Conditioning 16 Reinforcement versus Punishment Length of Reinforcement...19 Choice in Operant Conditioning...19 The brain and operant conditioning Case Study Using Integrated Theory Limitations Conclusion References.31

5 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 1 Oppositional Defiant Disorder: Issues And Interventions For Positive Behavior Management One of the main roles of teachers in the classroom is behavior management. Teachers provide education and assistance to students on a daily basis and often times meet challenges in doing so. Behavioral disorders can be one of the main challenges of teachers in today s classroom according to Keenan (2012). Keenan examined the common referral reasons for children to mental health clinics; Oppositional Defiant Disorder (ODD) was one of the main reasons for referral. Keenan (2012) identified that ODD is defined by the persistence of symptoms such as loss of temper, annoying others, defiance, and blaming others. The DSM IV-TR (2000) is the diagnostic tool used for diagnosis of ODD in children and identified the specific criteria and symptoms. The criterion for ODD to be diagnosed is a pattern of symptoms over a period of at least six months. These symptoms included arguing, refusal to comply, blaming, and resentfulness. In the study of year old pre-school students, who exhibited such symptoms, Keenan found that misclassification of individuals can often occur. The author noted that early testing could result in diagnosis leading to modifications needed for development. In the same study, Keenan also examined how ODD has characteristics similar to those of childhood disorders including conduct disorder (CD) and attention-deficit/hyperactivity disorder (ADHD). These similarities could lead to misdiagnosis of these childhood disorders amongst mental health professionals. School counselors and school psychologists must work together with teachers to clearly identify such symptoms in students in order to provide proper diagnoses, and define appropriate comprehensive functional intervention plans including behavior management techniques for these students to succeed in the classroom. Choice Theory provides a

6 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 2 framework for behavior interventions with students in the classroom and could be a successful tool when working with children diagnosed with ODD. Mason and Duba (2009) studied the effects of Choice Theory and Reality Therapy in schools in relation to the American School Counselor Association s National Model. The authors connect the Quality World aspects of Choice Theory in relation to the academic, personal/social and career aspects of the ASCA Model. In Choice Theory, the creator, William Glasser, focused on student s basic needs and how students go about fulfilling those needs (Glasser, 1988). Mason and Duba pointed out research-based evidence supporting the techniques of Choice Theory and Reality Therapy in schools and how the emphasis on choice and relationships can correlate to behavior that is more positive. The authors also point out how school counselors who utilize Choice Theory can create opportunities for the students along with how the student addresses choices in their life. These characteristics of Choice Theory can be used with students diagnosed with ODD to modify their behavior in positive ways. Another possible intervention for children diagnosed with ODD is the use of operant conditioning. Kirsch, Lynn, Vigotito, and Miller (2004) studied Operant Conditioning and its examination of cognition in relation to behavior. They noted the main goals of Operant Conditioning are to predict and modify behavior. They studied how behavioral change can be evoked through a response and outcome. Kirsch et al. also discussed how operant conditioning utilized positive and negative reinforcement for choices in order to modify behavior and make it more predictable. There are other cognitive methods that can be applied with operant conditioning such as systematic desensitization and placebo effects, which are covered in Kirsch et al. s study. The use of reinforcement through the operant conditioning model can possibly lead to behavior that is more predictable with students who are diagnosed with ODD. An intervention

7 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 3 with clear and consistent expectations for behavior can be established as a positive behavior approach with students with ODD. When working with children who are diagnosed with ODD, it is important to understand their cognitions and why they are making the choices they are. With the methods of Choice Theory, school counselors and teachers will have the ability to identify such choices, and examine them with the student to help the student weight both positive and negative outcomes. These outcomes can then be reinforced through Operant Conditioning to modify the behavior and make it more predictable. Therefore, the purpose of this paper is to propose an integration of Choice Theory and Operant Conditioning to work with students identified as ODD, and to discuss how utilizing them together in the classroom may be a positive and effective approach to modify student s problem behaviors associated with ODD. Literature Review Oppositional Defiant Disorder Characteristic of ODD. According to the Diagnostic and Statistical Manual of Mental Health (DSM IV-TR) (2000), Oppositional Defiant Disorder (ODD) is defined as: A recurrent pattern of negativistic, defiant, disobedient, and hostile behavior towards authority figures that persists for at least 6 months (Criterion A) and is characterized by the frequent occurrence of at least four of the following behaviors: losing temper (Criterion A1), arguing with adults (Criterion A2), actively defying or refusing to comply with the request or rules of adults (Criterion A3), deliberately doing things that will annoy other people (Criterion A4), blaming others for his or her own mistakes or

8 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 4 misbehavior (Criterion A5), being touchy or easily annoyed by others (Criterion A6), being angry and resentful (Criterion A7), or being spiteful of vindictive (Criterion A8) (p. 100). The criterion for this diagnosis is met through a frequent exhibition of such behaviors over a period of at least six months in relation to their developmental stages according to the DSM IV- TR. The DSM IV-TR also pointed out how persistent resistance and unwillingness towards peers and adults are instances of defiant behaviors. ODD has other characteristics that are important to note with the diagnosis in regards to age, gender, familial patterns, differential diagnosis, and causes. As the DSM IV-TR (2000) stated, ODD is diagnosed through the persistence of specific defiant behaviors towards authority. There are other specifics that go into this diagnosis including age and gender. Supporting Keenan (2012), the DSM IV-TR also noted the occurrences of ODD amongst pre-school children through adolescents. De Moura and Burns (2010) examined the behavior of kindergarten children diagnosed with ODD and wanted to identify toward whom the target of the defiant behaviors were. They noted how the target of the behavior might differ at various stages of development and relative age. De Moura and Burns studied how the behaviors started with parents before kindergarten, progressed towards peers and siblings during childhood, and then moved on to teachers and authority figures at school adolescence. This course of behavior is consistent with a pattern as highlighted by the DSM IV-TR (2000). The manual suggested how the behavior starts in the home setting and over time might appear in other settings. The DSM IV-TR stated that between 2% and 16% of children have symptoms of ODD. These findings were reported by parents and educators to identify patterns

9 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 5 of behavior and prevalence. The cause of ODD is an issue of controversy as parenting as well as brain functioning has been considered as potential causes. The DSM IV-TR (2000) reported the prevalence of ODD is higher for children among families in which at least one parent also had a history of mood disorders. The researchers also pointed out how mothers who have disorders such as depression may be more likely to have children with ODD. The most common relationship between ODD and familial factors is the correlation between children with ODD and families with marital dissension. Even so, Youngwirth, Harvey, Gates, Hashim, and Friedman-Weieneth (2007) researched and suggested there is more to ODD than just familial patterns. Neuropsychology & ODD. One theory about the cause of ODD is focused more on brain development and functioning. Brain functioning can be tested in multiple ways. Oosterlaan, Scheres, and Sergeant (2005) used psychological testing and intelligence tests to study children diagnosed with ADHD and ODD. Youngwirth et al. (2007) included a behavior assessment and a neuropsychological ability test when they tested children diagnosed with ADHD and ODD. Both of these studies looked to identify executive functioning impairments with diagnoses of ADHD and/or ODD. They both had similar difficulties related to executive functioning, but found different types of difficulties as results in relation to diagnoses of ADHD and/or ODD. Oosterlaan et al. (2005) performed a study on three groups of children diagnosed: those diagnosed with only ADHD, those diagnosed with only ODD, and those with a comorbid diagnosis of ADHD and ODD. They looked at executive functioning differences, defined as a cognitive process of execution, verification, goal directed behavior, and planning. They noted the prefrontal cortex of the brain served as the main catalyst for executive functioning. Reports

10 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 6 suggest the impairments in executive functioning occur in correlation to a diagnosis of ADHD where ODD may also be present. Oosterlaan et al. (2005) pointed out the similarities between the diagnoses of ADHD and ODD along with their frequency to accompany one another in the diagnosis of a child. The impairment of executive functioning could be due to deficits caused by a diagnosis of just ADHD, caused by deficits of a diagnosis of just ODD, or could be impaired by both diagnosis. Their study reported that executive functioning impairments were not reported in the children diagnosed with ODD. An ADHD diagnosis was associated with more errors in executive functioning. Youngwirth et al. (2007) performed a study using similar methods of assessments of behavior and neuropsychological functioning and found different results. Youngwirth et al. (2007) performed a study on the neuropsychological abilities of preschool-aged children diagnosed with ADHD and/or ODD. The authors noted high frequency of a diagnosis of ADHD and ODD amongst preschool-aged children. They also pointed out the persistence of each diagnosis stating that children who meet the criteria at the ages of four and six are likely to meet the criteria for the diagnosis for the next two to three years. Youngwirth discussed executive functioning in relation to children diagnosed with ADHD and ODD. Youngwirth et al. (2007) discussed executive functioning and the processing that goes into cognitive abilities such as: self-regulation, goal-directed behavior, planning, and cognitive flexibility. The authors noted how these abilities could be impaired due to diagnoses of ADHD and ODD. Their study reported some similarities between executive functioning with children diagnosed with ADHD and ODD but further research was needed. They discussed how the reports showed executive functioning deficits in children diagnosed with only ADHD and some have found that children with ODD also have deficits in executive functioning. The authors also

11 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 7 pointed out how neuropsychological impairments can be identified through testing. A more recent study by Hobson, Scott, and Rubia (2011) studied executive functioning of children diagnosed with ODD. Hobson et al. (2011) noted how often diagnoses of ADHD and ODD overlap with one another. There are behavioral similarities that are tied into both of these diagnoses in relation to how children behave and respond to adults. The authors discussed the neurological similarities and differences between individuals diagnosed with ADHD and ODD namely deficits in the prefrontal cortex. Hobson and colleagues point out the lack of research done on ODD independent of ADHD in relation to executive functioning and how their study would aim to research this subject group. Hobson et al. (2011) noted research done by Oosterlaan in relation to executive functioning and had different findings. The authors had two separate categories of functioning. Cool functioning was related to sustained attention, response execution, and motor inhibition. Hot functioning was related to risky decision-making. The research concluded that children diagnosed with ODD were more likely to have hot functioning deficits rather than children diagnosed with ADHD. The results of these analysis found that children diagnosed with ADHD do have executive functioning concerns but when ODD was independent of ADHD, there were also executive functioning impairments. The authors pointed out how these results are concurrent with MRI testing done in other studies relating to executive functioning. Fahim, He, Yoon, Chen, Evans, and Perusse (2011) also studied the neuroanatomy of children who have exhibited disruptive behaviors. They noted the atypical thought patterns of children diagnosed with ODD, which may lead to mistakes in decision-making. Fahim et al. also pointed out the issue of comorbidity of disorders of children diagnosed with ODD in relation to

12 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 8 anxiety and depression, and to ADHD. The authors noted how anger and disobedient behavior were areas of ODD, which needed to be studied. Their study through MRI scanning and IQ testing found evidence that activity in specific areas of the brain is related to specific disorders such as conduct disorder (CD) and ODD. The cerebral cortical thickness was observed as being thinner in the brains of children who exhibited disruptive behavior disorders, including ODD. Fahim et al. (2011) also examined violent behavior and its correlation to brain functioning. They noted the prefrontal deficits in humans in relation to how this area of the brain has an effect on behavior. The results showed how the subjects reacted impulsively and aggressively to situations which may be based off emotional responses. Fahim et al. reiterates the importance of a differential diagnoses between disorders such as conduct disorder (CD) and ODD. The neural findings from neural imaging of brain functioning support his reasoning in relation to how the subjects escalated and have persistent disruptive behaviors. They note the findings suggested that children diagnosed with ODD lack control over their actions due to the overstimulation of the front cortex (Fahim et al.) After this overstimulation, individuals with ODD lose control, which authors suggest lead to their lack of judgment and poor decisionmaking. These findings continue to bring up questions on the brain functioning and subsequent diagnoses of children with ODD. The similarities and differences among children diagnosed with ODD, CD, and ADHD continue to be the subject of debate (Oosterlaan et al., 2005; Youngwirth et al., 2007; Hobson et al., 2011; and Fahim et al., 2011). These studies support the need for ongoing research of the neuropsychological effects of the brain on children diagnosed with ODD and their level of functioning. With brain functioning possibly being an issue for children diagnosed with ODD, there are multiple treatments when working with these children.

13 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 9 Current Treatment Methods. Research-based recommendations in areas of pharmacological and behavior management have been delineated for the treatment of ODD. The pharmacological method of treatment is similar to the treatment of ADHD. Turgay (2009) examined such pharmacological treatments of both ODD and ADHD. The author discussed the importance of treating ODD early with medication, as ADHD is often times a concurrent diagnosis with it. Turgay pointed out psychostimulant medications like Adderall, Concerta, and Ritalin as appropriate pharmacological treatments for a longer period of time, but do not show significant improvements if used on a short-term basis. While pharmacological treatments have shown success, there are other approaches to treatment. This study is aimed to identify more behavioral approaches to working with families and children diagnosed with ODD. Larsson, Fossum, Clifford, Drugli, Handegard, and Morch (2008) conducted a study on treatment for children diagnosed with ODD and discussed how medication for ADHD was used regularly in the subjects as a positive treatment method. Larsson et al. utilized two separate types of treatment; that is, one for parents and one for children. The parent training was a twelve-week process including weekly meetings for two hours. The training included methods in discipline, parenting skills, coping with stress and also ways to build their children s skills. Larsson et al. examined how the therapist and the families worked in collaboration on the similar issues they had with their children. The child therapy treatment worked directly with the child and their ODD diagnosis. A group therapy method for the children in the study who were diagnosed with ODD involved on improving conflict resolution and social skills with peers (Larsson et al., 2008). Larsson et al. used role-plays, vignettes, and discussions as ways for the children to interact.

14 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 10 While the child therapy group was meeting, the parent-training group was also working on the same topics to allow for the families to make progress together. The study was able to conclude that there were reductions of aggressive behaviors in multiple settings. There were also improvements over a period of time with the child s behavior due to parent reporting from these methods. With the effectiveness of parent training, MacKenzie (2008) also utilized the method when working children diagnosed with ODD and their parents. MacKenzie (2008) discussed how Behavioral Parent Training (PBT) has been validated through research as a positive intervention for ODD. She pointed out how setting, groups, individual therapy, and techniques are all utilized as ways to treat ODD with families. The functioning of the child is the most important aspect of PBT. The training of the parents is also an important aspect covered by MacKenzie in order for them to distinguish between positive and negative behaviors and also being able to respond to them appropriately. Kelsberg and St. Anna (2006) also emphasized the importance of parent training including behavioral therapy for the child diagnosed with ODD. Kelsberg and St. Anna (2006) noted the positive results of parent training, parent modeling, and individual therapy with the children. They also noted a decrease in disruptive or aggressive behaviors over a continued period of time when appropriate parenting and behavioral skills were utilized. These findings support the approach to work parents and the child on ways to modify their behavior in specific settings. Behavioral therapy was cited as a way to decrease disruptive behaviors through the findings. The behavioral approach included problem solving, skills training, and cognitive-behavioral therapy. The authors found that an array of methods that helped to help with treatment of the individual in the home setting, and some of these methods can be transformed to the treatment of children diagnosed with ODD in schools.

15 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 11 Treatment in Schools. While parent training may be an important part of the treatment of students with ODD, schools still need strategies to work with students with the ODD diagnosis. Two plausible treatment methods that could be integrated to work with students with ODD in the school setting are Choice Theory and operative conditioning. These two treatment methods work towards predicting and modify behavior of the individuals. Choice Theory Choice Theory was developed for the school setting and provides a framework to working with students about choices even after they are made. Cameron (2009) examined the basic foundations of Choice Theory, which was created by William Glasser. Glasser (1988) created Choice Theory and used Reality Therapy as a way to work with individuals on analyzing their choices and behaviors in relation to five basic needs. There is an examination process of choices being made by the individual before and after choices occur. Cameron expressed the importance that Glasser put on the five basic needs as the driving force for an individual in their life and how the choices the individual makes influence these needs. These basic needs fulfill what Glasser referred to as the quality world. Mason and Duba (2009) also supported Glasser s Choice Theory when working with students on how to meet their individual needs. The relationship piece of Choice Theory and Reality Therapy is also a major focus and something to utilize when working with children who are diagnosed with ODD. The basic needs. Cameron (2009) researched the five basic needs of Choice Theory. These needs include: survival, love and belonging, power, freedom and fun. These five basic needs coincide with one another in and individual s life in order for them to fulfill those needs in their quality world.

16 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 12 Glasser (1988) examined how individuals make choices to fulfill each of these basic needs and rationalize their choices in their mind. Mason and Duba (2009) also discussed the motivation for these needs to be meet by an individual. As these five basic needs are defined, they can all apply to some of the behavior concerns that are symptoms of ODD. Taylor (2001) wrote about the change from defiance to cooperation. He noted some of the basic needs in his book as driving forces for children who are diagnosed with ODD. Power was discussed thoroughly as a need that children who are diagnosed with ODD thrive to have by any means. Rapport (2007) defined the basic need of power as the ability to feel important along with being respected and recognized by those in an individual s quality world. The basic need of power ties directly in with ODD as children who are diagnosed with ODD have issues with authority. According to Cameron (2009), the helplessness that goes along with the lack of this basic need could drive individuals to have a loss of control. This loss of control ties into the earlier research, which stated how individuals who are diagnosed with ODD could then make decisions leading to negative consequences (Fahim et al., 2011). The basic need of freedom relates to the basic need of power and how much control and individual has on their own life. Cameron suggests that the ability to make a choice is the basic need of freedom. This is directly connected with the need of power. When an individual has the ability to choose or make choices over the individual s life, the need of freedom is met which can also lead to meeting the basic need of power or having control in one s life. Rapport also pointed out how freedom can lead to major choices in one s life. He stated how the choices in one s life could either conform to norms or create new ones. When working with children diagnosed with ODD, these needs have to be carefully looked at and not judged.

17 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 13 Survival is another basic need covered in Choice Theory that can apply to children diagnosed with ODD. Rapport (2007) defined the basic need of survival as the most primitive need. This is the basic need for food, shelter, and clothing, and the need to live everyday and have security of your life. Taylor (2001) described survival as the autonomy of everyday life for the child diagnosed with ODD. He noted how important autonomy was for the child to survive through the basic needs that must be met. He portrayed a four-legged table that stressed importance of having the routine of and self-confidence. The routine and support in a child s life come for the author figures. These same authority figures are able to empower the child to make decisions over their life while supporting and caring about them. Taylor then described how the basic need of survival was met through the authority figures on one s life, and how they are also utilized to meet the basic need of love and belonging. Love and belonging also fall into this primitive category of the basic needs (Rapport, 2007). Taylor (2001) discussed how important it is for parents of children with ODD to show unconditional positive-regard when showing how much they love and care for their children. He suggests that showing love allows the child to gain a sense of importance or self worth, which is necessary for children who are diagnosed with ODD. Glasser (1988) felt the need for love and belonging was the most primary need. Mason and Duba (2009) noted love and belonging was the hardest need to have fulfilled due to the involvement of another individual. The authors pointed out how school counselors can create opportunities for those individuals to discuss the basic need and prepare them to make life choices in the future. The fulfillment of love and belonging is a difficult one to meet or to replicate.

18 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 14 As these four basic needs are met, there is a fifth basic need of fun. Rapport (2007) examined the basic need of fun as more than just the ability to laugh and learn, but as to the extent and individual desires to feel that way. Cameron (2009) also pointed out how many individuals do not take time to meet this basic need of fun, and it is often overshadowed by the quest to meet other needs, and therefore not met. Taylor (2001) discussed how fun could be developed through a relationship between children diagnosed with ODD and authority figures. Authority figures are the primary targets of children diagnosed with ODD; therefore, involving both authority and children in fun activities could lead towards building positive relationships for the future. In relation to counseling, Cameron pointed out the positive effects that humor can have with an individual over a long period of time. Cultivating positive relationships in counseling through humor would also be beneficial. It is important to note, that the most important aspect of the counseling work with individuals utilizing Choice Theory is the relationship. Relationship. Mason and Duba (2009) discussed the importance of the therapeutic relationship when utilizing Choice Theory with individuals in counseling. The client must have a sense of trust and understanding with the individual with whom they are working in order to share and identify the choices, they are making in their lives. Cameron (2009) identified the concept of total behavior in relation to Choice Theory. The concept of total behavior involves looking at an individual s behavior one instance at a time. This concept focuses on one area of the individual s life and allows the counselor to help the individual resolve one conflict at a time and then relate it back to their individual basic needs. Once one area has been resolved, the counselor and student can then move forward to other areas.

19 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 15 Similarly, when working with children diagnosed with ODD, it is important to understand what each individual concern is, rather than looking at every concern at once. One individual concern that Cameron (2009) pointed out is control. As stated earlier, the concept of control is important with children who are diagnosed with ODD, and helping them understand they can only control their own actions and no one else s is paramount. Taylor (2001) also discussed control as an underlying issue for individuals who are diagnoses with ODD. The striving need for power and control in the individual s life can cause them to lash out at those who are viewed as adults. Taylor pointed out how these authority figures can be seen in a very negative light as someone who is looking to take away from the individual s life. In relation to control, Taylor discussed how the individual must have an understanding of what they can and cannot control. This is a fundamental piece towards helping the individual gain a sense of hope. Mason and Duba (2009) also identified how important the instillation of hope is in the therapeutic relationship. The instillation of hope is geared towards creating a positive relationship with the individual and instilling the idea that things will get better. The counselor can work on improving the overall well being and providing a positive outlook on the future for the child diagnosed with ODD. The main purpose is to find out what is important to the child and what do they want to do with their life. This may be difficult for someone who is diagnosed with ODD, but the idea of hope and the relationship with the counselor can begin the early foundation towards this movement. When a child diagnosed with ODD meets with a counselor the first time, that counselor is now a part of the child s quality world. The individuals that make up the child s quality world have a direct effect on the fulfillment of their basic needs. Quality World.

20 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 16 Mason and Duba (2009) stated the importance of the quality world and how information from the beginning of one s life makes up their quality world. Specifically, the quality world is made up of people, information, beliefs, and relationships along with the basic needs. They noted the importance of people in the quality world and when working with children diagnosed with ODD, this is important to highlight. They examined how the counselor or person working with the individual must represent someone positive in their life and someone who can help the individual in order for that person to be a part of the person s quality world. Cameron (2009) also pointed out how the counselor s ability to be part of the individual s quality world can greatly improve the rate of success with that individual. When the child who is diagnosed with ODD allows the counselor or teacher to be a part of the individual s quality world, the work can then begin on analyzing the choices the person is making and how the individual s life is being affected. Treatment with Choice Theory and Reality Therapy. Choice Theory is the theoretical framework by which Reality Therapy is utilized (Mason & Duba, 2009). They discussed how Reality Therapy could be utilized in the school as a way to work with children to analyze the choices they are making. They also examined how important it is for the counselor to not judge the children about their choices, but support them through the events in the person s life. The counselor s main objective is to identify what basic needs are getting met and not getting met through the client s choices. In the implementation portion of this paper, this will be identified more closely when working with children who are diagnosed with ODD. When analyzing the choices of an individual, the operant conditioning model can be utilized as a way to identify positive and negative consequences and then provide positive and negative reinforcement for the choices that the individual is making.

21 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 17 Operant Conditioning B.F. Skinner (1969) coined the term operant conditioning and used it as a way to examine the environment and behavior. Skinner also developed the term operant behavior. Operant behavior is behavior controlled by consequences and reinforcement. Reinforcement is a main part of operant conditioning, and can be used to predict behavior (Staddon & Cerutti, 2003). Staddon and Cerutti also pointed out how choice is involved in operant conditioning. They refer to how an individual makes a choice between multiple responses. They looked at why the choice was made and what the alternatives were for the individual to make the choice. The authors also identified reinforcement as modifiers in choice. Reinforcement is one the main components to operant conditioning (Skinner). These reinforcements can be positive and negative and differ from punishment. Positive reinforcement is the addition of a pleasurable stimulus to continue the behavior. Negative reinforcement is an increase or sustained behavior with the negative condition (consequence) of the behavior being stopped or avoided. Punishment causes the behavior to cease temporarily while the stimulus is removed (Shields & Gredler, 2003). The definitions are often confused with one another and will be separated in order to clearly present behavior management techniques for children diagnosed with ODD. Reinforcement versus Punishment. Shields and Gredler (2003) studied Skinner s operant conditioning and identified ways to teach it to others. The importance of reinforcement relates to how an individual can perceive it. Shields and Gredler noted that positive reinforcement is often perceived as a reward. Additionally, negative reinforcement is similar to a punishment for a negative behavior, and the two terms could not be distinguished. They looked to develop a study for individuals to identify positive and negative reinforcement along with distinguishing punishment as well.

22 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 18 Shields and Gredler (2003) used Skinner s model to define positive reinforcement as a way to stimulate a continued response. This would mean making the individual continually act a certain way without a negative stimulus. They noted how desire is not a characteristic of positive reinforcement, rather some individuals do not desire the positive stimuli but simply continue the behavior because it is what is supposed to be done. The authors continued to define negative reinforcement and how it is different from punishment. Shields and Gredler (2003) noted how negative reinforcement and punishment are often times viewed as the same thing. They wanted to separate the two terms and show their differences. The authors suggested the negative emotional response that comes with punishment as a reason that the terms are viewed as the same. Negative reinforcement, however, is when a behavior is strengthened by removal of a negative stimulus. An example of negative reinforcement would be if a teacher were to tell students that the they will have a quiz at the end of the week (negative stimulus), but cancels the quiz (removal) if all homework gets turned in on time; thereby increasing (or reinforcing) the likelihood that homework gets done. This would entail having a negative reinforcement for the individual for every instance that the person exhibited a said behavior. There is still a stimulus when negative reinforcement occurs. On the other hand, punishment is the removal of the stimuli leading to instances of the behavior decreasing. An example of punishment would be detention in schools. Detention is used as a way to stop a specific behavior from a student. If the student exhibits the same types of behavior after detention, they will receive another. This is a cycle of a form of punishment geared towards stopping specific behaviors. Shields and Gredler (2003) examined how punishment evoked the negative emotional response from the individual. To distinguish negative reinforcement from punishment, the behavior occurs and the stimulus remains in negative

23 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 19 reinforcement. With punishment, the stimulus is removed for the behavior to cease. Punishment includes consequences for behavior in order for a behavior to stop. The number of occurrences can affect the modification process of a said behavior as Shields and Gredler point on. Additionally, Staddon and Cerutti (2003) examined the number of occurrences over a period of time and how that would affect the individual and the modification process. Length of Reinforcement. Staddon and Cerutti (2003) identified the key components to operant conditioning and modifying behavior of an individual. They noted how operant behavior is aimed towards repetition of a behavior and how time can have an impact on the reinforcement. The pattern of behavior is aimed to be predictable (or repeated) and offers reasons for the behavior to continue. These reasons are the positive reinforcers that increase the likelihood of the behavior. The authors identified how sustainability of behavior can be increased with positive reinforcement. This is a modification technique for the behavior to continue over a period of time in which the individual is conditioned to behave in a certain manner. Staddon and Cerutti discussed how the behavior could also be modified with a given response with negative reinforcement. This is aimed towards the opportunity to give the individual an inherent understanding of the choices they make. Taylor (2001) discussed the idea of continual behavior monitoring with children diagnosed with ODD. He focused on prevention of behaviors through a series of rules and guidelines for the child. These include sufficient nutrition, efficient sleep, supervision, and need-meeting activities. This model expresses the need for consistency and autonomy for the child diagnosed with ODD. Choice in Operant Conditioning.

24 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 20 Staddon and Cerutti (2003) identified the importance of choice in relation to operant conditioning. They discussed how choice is difficult to directly observe. The individual makes a choice, and then there is a consequence following the individual s choice. It is difficult to go inside the person s head and understand how the choice is made. With operant conditioning, Staddon and Cerutti pointed out how the consequences can influence their choices, but it is not the defining reason to explain choice. Choices are made through executive functioning and could be related to deficits in the brain (Fahim et al., 2011). The brain and operant conditioning. Rapanelli, Frick, and Zanutto (2011) examined the brain in relation to operant conditioning and how choices were being made in relation to behavior. Rapanelli et al. (2011) researched the prefrontal cortex in relation to operant learning. They looked at learning a task, the environment, and voluntary exercise. Their research was focused on animals, and used the results to explain the functioning that goes with operant conditioning. They noted the importance of operant learning for directed behaviors. The explained how the cells of the medial prefrontal cortex (mpfc) and hippocampus (HIPP) were produced and how cells were created through this experience. As stated earlier, children who are diagnosed with ODD have shown areas of concern in the mpfc. Fahim et al. (2011) discussed the neurological concerns with brain functioning of children diagnosed with ODD. When working with a child diagnosed with ODD, the counselor must address these neurological concerns. This would involve identifying any cognitive delays that the individual has. Additionally, the counselor would work with the individual on the thought making process and what causes the individual to make specific behaviors. The counselor must have an idea of how the child s brain functions in relation to choice. The counselor can then come up with a plan to improve the child s decision-making

25 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 21 process. The decision making process of a child diagnosed with ODD is impaired, and those who work with them must be prepared to offer proper alternatives in order to see positive results. Fusing the models of Choice Theory and operant conditioning, appropriate and positive behavior management can utilize techniques for children who are diagnosed with ODD.

26 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 22 Integrated Case Study In order to provide an illustration of the methods of Choice Theory and operant conditioning when working with a child diagnosed with ODD, a case study has been created. This case study involves Baxter, an eight year old student, and Karin, his school counselor at the elementary school. Due to behavioral issues in the classroom, Baxter s third grade teacher referred him to Karin, the school counselor. Baxter has a history of behavioral issues in the classroom, at home, and on the school bus. Baxter has recently failed to meet the expectations of the class and does not comply with the rules of his teacher. Baxter s parents both work full time to provide for him and his two sisters, who are ages six and four. They have both reported instances of Baxter not complying with household rules and arguing with them constantly. Baxter also exhibits inappropriate behaviors on the bus to school. He has been seen running up and down the aisle of the bus and not listening to the driver or aide. Baxter has been suspended from using the bus for a period of one week due to a recent complaint where he began screaming at the bus driver and would not sit down while they were at an intersection. Baxter s mother has to drive him to school for the week and misses an hour of work to do so. Karin has been a school counselor for 8 years. She has a theoretical background in cognitive behavioral techniques along with play therapy. She has met with Baxter in the past for behavioral issues and also emotional aspects of his life. Karin has recently been studying the effects of operant conditioning along with the methods of Choice Theory when working with children diagnosed with ODD and decides to utilize them with Baxter. Karin has developed a plan to work with Baxter, his teacher, and his parents on outlining a plan for positive behavior management techniques utilizing Choice Theory and operant conditioning.

27 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 23 Karin set up her meeting with Baxter in her office, as Baxter enjoys playing with some of the toys from the sand tray. Karin has a rapport built with Baxter due to her individual and group counseling work with him. She has utilized play therapy and other behavioral modifications in the past as ways to help Baxter with short-term effects. Karin recently studied the effects of the brain in children diagnosed with ODD. When approaching Baxter s case, she wanted to identify the issues related the neurological deficits that ODD may bring about. When utilizing Choice Theory and operant conditioning, both sides of the discussion can be covered. Cognition of choice is a major piece to Choice Theory while also focusing on choices that were made in the past. Karin will help Baxter identify choices he has made recently and try to better understand why he made those choices. With Baxter being eight years old, his rationale may be difficult to understand, but one of the essential pieces of Choice Theory is to not judge the client for the choices they have made. It is better to give the student various perspectives on the consequences (Glasser, 1988). After going through the consequences, Baxter can pick one, which can be reinforced with operant conditioning. The process of continually repeating behaviors with positive stimulus will be important for Baxter to see how his choices after what happens to him. Karin understands that Baxter sometimes acts out by exhibiting behaviors such as arguing, annoying, and defiance because it is fun for him. Operant conditioning offers a model of reinforcement for positive behaviors over negative. The stimulus of fun is still there, however, determining which is more fun in Baxter s eyes will be important to the success of his goal attainment. Karin will utilize positive and negative reinforcement with Baxter s teacher and parents while emphasizing a decrease in punishment for negative behaviors. Karin has the

28 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 24 opportunity to meet with Baxter twice a week for twenty-five minutes in order to work on these presenting concerns. The initial sessions with Baxter were challenging for Karin because Baxter wanted to play with the sand tray. Karin focused on setting clear boundaries for when he could play with the sand tray. Karin also kept the rules to a minimum in order to keep the sessions fair in the eyes of Baxter (Taylor, 2001). Karin also focused on creating a deal for Baxter (Taylor). She discussed what she wanted from him including listening, sharing, following rules. In return, Baxter would then receive five minutes of playtime at the end of the session to use the toys in the sand tray. This works on both levels of Choice Theory and operant conditioning. Karin is supporting Baxter s need for fun by giving him the opportunity to play with the sand tray. Karin is also empowering Baxter to have control over his behavior in order to achieve a goal he wants (i.e., playing in the sand tray). These small behavior changes are methods of operant conditioning by continually positively reinforcing behaviors for the client resulting in a stimulus of what the person wants. This model then needs to be carried over to the classroom and home setting. In both the classroom and home setting, Karin needs to help the teacher and parents identify things that Baxter strives to do. She wants to focus on positive stimuli for him to seek and then attain through measurable behavioral goals. When working with Baxter, Karin knows he will not change overnight, but more importantly, neither will the parents or the teacher. In both cases, the teacher and parents have other kids they need to be aware of as well as Baxter. The teacher has twenty-three children in her classroom. There are several students who have behavioral issues as well as others with learning disabilities, but the teacher has identified Baxter as the student that has had the most interruptions to the class. The techniques for working

29 Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 25 with children diagnosed with ODD can be used for most children; however, more focus is needed on consistency for those with the diagnosis of ODD. Karin works with the teacher on being consistent and not engaging in power struggles. Baxter continually tries to enter in power struggles with adults in order to annoy and not follow the adult s directions. He has stated that this is fun for him, and he enjoys doing it. The relationship between Baxter and his teacher must be built upon the goal of finding fun. Some specific instances of relationship building activities that meet his need for fun include games and one-on-one time. This will be difficult to attain due to the size of the class, but can be approached if only for moments throughout the day. The teacher has to look for opportunities to spend quality time with Baxter in order to build up their relationship (Taylor, 2001). Along with this relationship, there will be a need to find instances of what Baxter likes to do in order to set up a plan for him to achieve time doing those activities. At school, Baxter enjoys recess. He enjoys running around and playing ball with other kids. He also enjoys playing with Legos. One of the major issues this year has been the absence of playtime in the third grade classroom as compared to the second grade classroom. Baxter has noted feeling that the teacher does not want him to play. Thus from the outset, this relationship already has a negative connotation. Baxter does not feel like class is fun, he does not feel like he has freedom to do what he wants to do, and he also feels like the teacher does not let him make decisions about any of these issues. Therefore, the basic needs of fun, freedom, and power are not being met. There are constructs that do not allow Baxter to simply do whatever he would like to do, and that has been difficult for Karin to help him to understand. She has used models and pictures to help him cognitively approach where he can do certain activities and where he cannot. These are pictures of his classroom with children doing certain activities. With his executive functioning being of concern, these pictures can be utilized to help him identify